Don’t knock hospital food. Catering for a hospital is completely different from catering for a restaurant. One, it’s a far more complex process because the requirements of a diverse group of patients with different nutritional needs has to be met. Two, most patients have poor appetite due to their medical condition or refrain from certain foods due to pantang larang (taboos). Mix the two together and it can cause quite a headache, writes HOOI YOU CHING.
THERE is nothing quite glorious about hospital food, admits consultant dietitian Lim Kwee Ean of Besta Food Service. “One of the most common complaints from patients is that hospital food is bland. It’s true that taste ultimately influences food intake and hence, the process of recovery. But you cannot expect food to taste good when you reduce the ingredients that enhances its flavour. For example, hospital chefs use a mere two teaspoonfuls of oil to cook a meal which consist of meat and vegetables,” explains Lim.
Clearly, hospital food cannot offer the best of both culinary and curative worlds when it’s the latter that takes precedence in medical care.
“At the end of the day, we as healthcare providers are advocators of healthy eating. Therefore, one of the challenges we often face is finding ways to introduce food that is both nutritious as well as tasty. A diet is only successful if it’s eaten,” reasons Lim, who was formerly Universiti Malaya Medical Centre’s (UMMC) chief dietitian.
Generally, healthy eating refers to consuming food that is low in fat, cholesterol, sugar and salt. Based on Besta’s Hospital Diet Practice Guide, the dietary requirements for a regular diet are as follows: energy (1800 - 2000 calories), carbohydrate (50 - 55%), protein (15-20%) and fat less than 30% of energy value.
However catering for a hospital is completely different from catering for say, a restaurant. In fact, the hospital food service operation is a far more complex process.
One of the biggest challenges hospital caterers face is feeding such a diverse group of patients with different nutritional needs. Adding to that is the fact that most patients have poor appetite due to their medical condition or refrain from certain foods due to pantang larang (taboos). Often too, patients can’t appreciate hospital food for the simple reason that it is not food (read: home-cooked food) they are accustomed to.
In order to achieve greater efficiency and economies of scale, several major hospitals have assigned their food service operations to independent companies. One of these commercial entities is Besta Food Services, whose clientele includes Hospital Selayang, Hospital Putrajaya, Universiti Malaya Medical Centre (UMMC) and Hospital Universiti Kebangsaan Malaysia.
Recently, Besta launched the Hospital Diet Practice Guide, a reference book on methods and practices in the hospital catering system. It contains a step-by-step system of standardising and monitoring food provision in hospitals.
According to the guide, the hospital menu is divided into two diet types: the standard and therapeutic diet menu.
The regular diet is designed to achieve and maintain optimal nutritional status in patients who do not require medical nutritional therapy (i.e. the use of specific nutrition to treat illness, injury or health conditions).
On the other hand, the therapeutic diet is a modification of the regular diet. This type of diet may take several forms, such as a pureed diet for patients who have difficulty in chewing and/or swallowing or a calorie-modified diet for a diabetic person.
Apart from conforming to dietary guidelines, patients are offered a choice in the menu to provide for variety, thus dispelling the myth that hospital diets are monotonous.
There are different diet regimens to accommodate different patient types. Children may not like the adult diet and so special consideration is taken into account when it comes to catering meals for them. For example, the paediatric diet offers fish fingers, cereals and chocolate milk while ensuring that foods that commonly cause allergies, intolerance and choking are avoided.
According to Lim, the standard diet menu also takes into account the nutritional needs of expectant mothers.
“During the second and third trimester of pregnancy, an additional intake of 300 kcal/day is required. Adequate protein intake is also essential for normal foetal growth. This is because pregnancy is an anabolic state where adequate nutrition influences a favourable course and outcome for both mother and foetus. Here, the diet emphasises an increase in calcium requirement.”
She adds that meals prepared for moms-to-be usually contain black pepper, garlic and ginger. This is based on local beliefs that these spices and herbs help to expel wind and provide the increased heat and warmth during pregnancy.
“Some may experience cravings for certain foods due to hormonal changes. Certain patients won’t eat eggs or perhaps take only a particular type of fish. Pineapples are a no-no for pregnant women,” she continues.
Meals prepared for geriatric and cancer patients also take into account factors such as the ingredients’ texture and consistency. For instance, food for the geriatric patients also tends to be less spicy and oily whereas meats and vegetables are minced for easier chewing and swallowing.
“For cancer patients undergoing treatment, the nutritional challenges are manifold due to decreased appetite, swallowing difficulties, dry mouth, mouth sores, loss of taste, nausea and vomiting. Therefore, it is important for hospital dietitians to work closely with the Besta team to ensure that the dietary and nutritional needs of cancer patients are taken care. In this case, an a la carte menu is offered,” she says.
According to the guide, a food exchange list is used to plan the menu for regular and therapeutic diets. The list contains a group of foods in which specific amounts of the foods listed are approximately equal in carbohydrate, protein and fat value. Thus, any food within a given list can be substituted for other foods in that list. The regular diet menu also comes with three choices including spicy, non-spicy or vegetarian.
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